Healthy Sleep Patterns, Mortality, and Life Expectancy in Adults With and Without Atherosclerotic Cardiovascular...

Healthy sleep is a multidimensional behavior critical for chronic disease prevention, yet its long-term impact on mortality and life expectancy-particularly among individuals with atherosclerotic cardiovascular disease (ASCVD)-remains unclear.

The purpose of this study was to evaluate the associations between sleep patterns and mortality and life expectancy among adults with and without ASCVD.

We analyzed data from 148,622 U.S. adults (mean age 48.4 years, 50.6% female) in the National Health Interview Survey (2013-2018), with mortality follow-up through December 31, 2019. A composite sleep score based on 5 self-reported behaviors was constructed to categorize participants as having poor, intermediate, or healthy sleep patterns. Multivariable Cox models estimated hazard ratios (HRs) for all-cause mortality, and life expectancy was calculated using a flexible parametric survival model.

Over a median 4.3 years of follow-up (IQR: 2.8-5.5), 5,643 deaths occurred. Compared with those with poor sleep patterns, participants with healthy sleep patterns had significantly lower all-cause mortality, both among individuals with ASCVD (HR 0.74, 95% CI: 0.62-0.89) and those without ASCVD (HR 0.82, 95% CI: 0.70-0.95; P for additive interaction = 0.03). At age 45, a healthy sleep pattern was associated with an estimated life expectancy gain of 3.0 years (95% CI: 1.1-4.8) among individuals with ASCVD, and 1.5 years (95% CI: 0.3-2.6) among those without.

Multidimensional healthy sleep patterns are associated with lower mortality and increased life expectancy in adults, with greater absolute benefits observed in individuals with ASCVD.